IHE Eye Care Charge Posting

1. IHE Eye CareCharge Posting Donald Van SyckleDVS Consulting, Inc.www.dvsconsult.com

2. Charge Posting Profile:Features • Facilitates Collection of Procedure Details for Billing • Performed Procedure Technical Fees • Materials Usage • Future - Reporting Professional Fees • Etc. • Facilitates Management of Account Details in Multiple Systems and Procedure Records

3. Benefits • Reduces Billing Errors • Ensures Complete and Consistent Data • Less Billing Resource Requirements • Reduces System Interface Installation Time • Reduces the Need of the Billing System to Have Knowledge of Eye Care System • Eliminates Redundant Data Entry and Maintains Data Integrity • Provides Operational Cost-effectiveness

4. RESULT Charge Processor will receive more complete, timely and accurate data.

5. Types of Billing Charges • Technical Charges • Fees for the actual procedure • Typically eligible at procedure completion • Information on materials used • Professional Charges • Not being addressed this year, but plans to add soon Ensuring the required data is complete is the responsibility of the Charge Processor and is outside the scope of IHE and will be determined by the clinic policies

6. Patient Information Account Complete BILLINGSYSTEM EMR Procedure Information Modality Workflow – need EC PICS Initial Capture of Patient Demographics PMS BENEFITS Redundancy Eliminated Maximum Data Integrity Billing Available ASAP All Systems Updated

7. Technical Details • HL7 Messages manage account details between systems • Open, Update, Close Account • DICOM Performed Procedure Step Messages (MPPS) provide details to Order Filler from the modality: • Performed (Billable) Technical Activities • Usage of Materials • HL7 Messages allow Order Filler to post charges to the Charge Processor (financial system)

8. Transaction Diagram

9. Workflow • Charge Possessor receives patient/account information from ADT/Patient Registration • An order is generated for the patient and a procedure is performed on a Acquisition Modality (part of SWF) • ORM, MWL, MPPS, …… • DSS/Order Filler indicates to the Charge Processor that procedures are available for Technical billing (using HL7) • Charge Posted Transaction may be sent at various times in the workflow • Regulations and site policies determine when a procedure is eligible for Charge Posting

10. Account Management Transaction Collects information relevant to the patient account and submits it to the Charge Processor

11. Actor: ADT/Patient Registration • Sends the message whenever a patient is: • Pre-admitted • Admitted • Sends P01 event to add a new account • Sends P05 (update account) event used to update an existing account • Send P06 (end account) event used to close an account • Optional features • One or more DG1 segments - Patient’s Diagnosis • One or more GT1 segments – Guarantor Information • One or more IN1 segments - Insurance Information

12. Message Segment:P01 - New Account

13. Message SegmentP05- Update Account

14. Message SegmentP06 - End Account

15. Actor: Charge Processor • Receives patient demographics, account info, etc. for ADT/Patient Registration • Receives the posted charges and serves as a component of the financial system. • Note: When and how the actual billing is trigger is is beyond the scope of IHE.

16. Actor: Department System Scheduler /Order Filler • Receives/Collects patient information through existing HL7 ADT messages (defined in SWF) • Upon a defined workflow action (i.e. MPPS from modality), makes procedures available for charge posting • The actions/events that actually causes charges to post is defined by the actor • Maybe convert procedure codes to CPT codes • Maybe include diagnostic reasons for procedures (ICD) codes • Send charge message upon receipt of MPPS or require manual confirmation • Others……

17. Interaction Diagram

18. HL7 DFT Message Semantics • Describes a financial transaction transmitted between the DSS/Order Filler and the Charge Processor • DSS/Order Filler uses information from the Modality Performed Procedure Step Completed/Discontinued transaction to verify the procedure has been completed • Includes the DICOM Billing and Material Management Code Module which provides procedure, materials and devices information • DSS/OF maps information from DICOM world to HL7 world • The Charge Posted Transaction will transmit Detailed Financial Transactions (DFT) messages using the P03 event • May convert procedure information from MPPS to CDT codes, etc. • One or more PR1 segments shall be present if additional procedures, materials or devices are present (more then one modality)

19. Message Segments

20. Trigger Events • Procedure Ordered • Procedure Scheduled • Procedure Completed • Future will define Report events for professional fees

21. Actor: Charge Processor • Receives patient demographics, account info, etc. for ADT/Patient Registration • Receives the posted charges and serves as a component of the financial system. • Note: When and how the actual billing is trigger is is beyond the scope of IHE.

22. More information…. • IHE Web site: www.ihe.net • Technical Frameworks • ihe_eyecare_tf_rev1.0TI_vol1_2006_xx_xx • ihe_eyecare_tf_rev1.0TI_volw_2006_xx_xx • Non-Technical Brochures : • Anything else we want to point to?